Lights On, Rats Out: A Memoir

By Cree LeFavour

“A harrowing, beautiful, searching, and deeply literary memoir. In these pages, we watch Cree LeFavour evolve from a wounded (and wounding) lost girl to a woman who can at last regard her existence with a modicum of mercy and forgiveness...a story of true self-salvation and transformation.”—Elizabeth Gilbert

As a young college graduate a year into treatment with a psychiatrist, Cree LeFavour's began to organize her days around the cruel, compulsive logic of self-harm: with each newly lit cigarette, the world would drop away as her focus narrowed to an unblemished patch of skin calling out for attention and the fierce, blooming release of pleasure-pain as the burning tip was applied to the skin. Her body was a canvas of cruelty; each scar a mark of pride and shame.

In sharp and shocking language, Lights On, Rats Out brings us closely into these years, allowing us to feel the pull of a stark compulsion taking over a mind. We see the world as Cree did—turned upside down, the richness of life muted and dulled, its pleasures perverted. The heady, vertiginous thrill of meeting with her psychiatrist, Dr. X—whose relationship with Cree is at once sustaining and paralyzing—comes to be the only bright spot in her mental solitude.

Her extraordinary access to and inclusion of the notes kept by Dr. X during treatment offer concrete evidence of Cree’s transformation over 3 years of therapy. But it is her own evocative and razor-sharp prose that traces a path from a lonely and often sad childhood to her reluctant commitment to and emergence from a psychiatric hospital, to the saving refuge of literature and eventual acceptance of love. Moving deftly between the dialogue and observations from psychiatric records and elegant, incisive reflection on youth and early adulthood, Lights On, Rats Out illuminates a fiercely bright and independent woman’s charged attachment to a mental health professional and the dangerous compulsion to keep him in her life at all costs.

• Language: English
• Publisher: Grove Press
• Release date: Aug 1, 2017
• ISBN: 9780802189158

Cree LeFavour

Cree LeFavour is a cookbook writer who grew up on a ranch in Idaho. Her books include The New Steak . She lives with her two children, Penn and Harriet, and her husband, Dwight Garner, in Frenchtown New Jersey.

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PART I

POTTER: Oooo. It damn well ‘urts.

LAWRENCE: Certainly it hurts.

POTTER: What’s the trick, then?

LAWRENCE: The trick, William Potter, is not minding …

—Harry Fowler as William Potter and Peter O’Toole as T.E. Lawrence in Lawrence of Arabia

To cease utterly, to give it all up and not know anything more—this idea was as sweet as the vision of a cool bath in a marble tank, in a darkened chamber, in a hot land.

—Henry James, The Portrait of a Lady

Pain has an element of blank;

It cannot recollect

When it began, or if there were

A day when it was not.

—Emily Dickinson, The Mystery of Pain

CHAPTER 1

Kid Gloves

1st degree: a superficial burn of the epidermis. Grazing the bare forearm against a hot baking sheet loaded with sugar cookies might cause such a minor infliction. 1sts heal in days and leave no scar. Baby stuff. At the other extreme, the most severe 4th degree extends through the epidermis and dermis, damaging the subcutaneous tissue, including muscle and bone. House-on-fire-and-no-way-out bad. This meanie requires excision, a word as hideous as the procedure: cutting away and removing dead flesh and damaged bone only to repair the gap with grafts of healthy skin harvested from elsewhere on the body.

At the upper middle of the order settles the fetching moderation of the 3rd. It destroys the epidermis and much or all of the dermis beneath but no muscle or bone. Yep. Three is my number, although I do flirt with upper 2nds in weaker moments or when rushed. I’ve done a lousy job before and the proof of it is no end of pain—2nd-degree burns hurt—it’s a problem creating its own reward as I go back in to fix things up.

3rds and 4ths can be done with a lit cigarette if you try. It’s all about the prolonged action of any intense form of heat. That cherry glow produced by a puff on most factory-made cigarettes produces roughly 900°F heat; a smoldering cigarette hovers around 400°F. The royal tell is not just a loss of sensation but an unmistakable leathery, hard yellow-brown surface. Snakeskin boots. Alligator hide belt. Kid gloves. Getting there takes holding the cigarette in place until the pleasure’s spent. No less than one cigarette will do, with plenty of puffs in between to keep it lit, but two work better, allowing moments of leisure to enjoy the experience between drags. In a severe 2nd or 3rd the blister takes hours, not minutes, to appear. When it does, there’s no change at the center, although the spot may be circled by a delicate golden pus-engorged halo. 4ths are entirely above such mess.

I know I shouldn’t get hung up on the numbers. Guillaume Dupuytren’s original 1832 classification of burns orders a lax spectrum even if its weak logic crushes the chaos of the modern bible of psychiatric disorders, the Diagnostic and Statistical Manual, or DSM. Then again, the deranged Richter scale, with its base-10 logarithmic formula, in which an earthquake registering 6 on the Richter scale is ten times stronger than a 5, makes the other two seem simple. All three models muster their sorry best to grade extremities of damage only to confound what might have been made tangible. Dupuytren’s fixation on a burn’s depth starts to appear positively sensible next to the seismographic measure of earthquakes or the numerically crazed symptomology of mental illness.

Whatever the number, eventually the skin sloughs off in one round piece. What grows back a month later or more is not new skin—neither dermis nor epidermis—but scar tissue, pink at first, later white. It will never disappear, only flatten and fade over the years from pink to silver to white. It’s all collagen like the miraculously perfect surrounding skin, but the fibers arrange themselves not in a neat basket weave but in a unidirectional mess. Fibrosis.

I hate to leave a spot lightly touched. There’s no going halfway—1sts are a joke and minor 2nds aren’t my element. For one thing they hurt—later, when I don’t want them to. It’s curious not minding intense pain. It means, among other things, that I can go back over burns done feebly, old or new, partially healed but still pink, wet, as if they’re done. But they’re not. They’re in play, ready for more. Ready for service.

Right now I need skin and my options are limited. I’ve been busy. Not only am I running out of time, but the sorry facsimile of a cast—gauze masquerading as plaster—blocks access to the choicest spots. Amounting to little more than two and a half yards, 2.2 meters wide, it is evidence of what I experienced as porn-level excitement when at my last appointment Dr. Kohl revisited his dormant medical skills: disinfecting, dabbing, placing pads, layering gauze, securing all with two lengths of medical tape. The bandage is tangible proof of my psychiatrist’s attention and through it I track a juicy snatch of time. I know my attachment to it is no more logical than a lusty squirrel’s persistence in guarding a cache of empty, broken walnut shells.

Johns Hopkins’s proud. Go Blue Jays! Enough talk therapy. Let’s practice real medicine. Leaning close, my psychiatrist, Dr. Kohl, cradled my arm as he tenderly dabbed ointment and then meticulously wove the sterile gauze from wrist to mid-biceps. There’s no escaping it—without the dignity of a blank slate of plaster awaiting fond words and doodles the appearance of this unwieldy thing I’m so assertively attached to must disappoint. It’ll have to do. I know that what the shell conceals isn’t all bad: A heavy coat of white silver sulfadiazine ointment cools the flesh beneath squares of Telfa nonstick pads. The pads guard roughly one hundred wounds—in various stages of recovery—from the grab of the gauze that, other than being spectacularly showy, is there to hold the pads in place and absorb pus. The skin at the bottom of the assemblage is not so much skin as an oozy landscape of red, pink, white, and yellow flesh speckled with fresh scars. Inexplicably, I adore the whole gruesome mess.

I home in on the palm rather than destroying a shred of his sacred evidence. It’s definitely available. Naked, fleshy, and thick, abductor pollicis brevis, flexor pollicis brevis, and adductor pollicis—the three muscles control the thumb.

I pause, focusing on the torn foil frame where seven circular butt ends compete for attention, their claim to distinction driven by no logic other than a conspiracy of confusion in which one or the other tries to stand out as it. The admittedly illogical project is to see beyond the trick, to divine the real, right one—sorting through the decoys occupies the greater part of the work. Thirty seconds pass before I recognize the one I’m meant to choose at the edge, half obscured by a wafer of shiny silver paper.

With a gentle pinch it’s between my lips. One practiced motion: wrists in a huddle, hands cupped to protect against a nonexistent wind, head down, thumb grinding the ridged metal wheel, flame popping cheerfully into view as it meets the cigarette’s raw end. A pull of breath completes my business as the precisely cut and glued paper sacrifices a few filaments of dry, broken tobacco leaf, fragile and ready for destruction as finely grated chocolate. The confident flame coaxes the dormant object to life, a lambent coal its proof. The first drag—now this is what lungs are for.

It can take a few seconds but once I muster the determination to land the burning end on the pristine skin I’ve chosen for the purpose, once I make initial contact, my mind and body blossom into exhilaration. The sensation reads as pain—hot and fresh. But when its animal simplicity surges landing on whatever part of my brain, whatever section of that flaccid organ occupies the space just behind my forehead, I own it. Like nothing else, I am here. I am positioned. I am.

Holding the cigarette down, I focus on the intensity, its deep center, its hyper-sensory wake. Drawing on the cigarette, bringing it back to life, going back in. Holding. Holding. Holding it down. Focusing on the pain, willing it into something else entirely. Clarity. Filter nearing, part of me relieved it’s almost over. Fading. I hold it there as it makes its way deeper but I’ve already nailed the forbidden flush of transcendence; it lingers. And again because it’s not over yet.

Sucking the cigarette a few more times to use the last of it, I hold it down, edging it wider for a jolt here and there as it finds a fresh nerve beyond the neat circumference I’ve created. The burned edge of the paper, barely alight, is the destroyed ground the camel on the rubbery filter appears to cross; it never fails to evoke the film image of T. E. Lawrence’s exhausted animal Jedha crossing the Sinai Peninsula. I crush it right on the spot, hitting hard skin that sheds the gray-black ash, leaving behind a few flecks of cinder and enough ash to obscure a yellow center now the color of a fifty-pack-years smoker’s index finger.

Then I do another. And another. One for my cheek. Three on the top of my foot. Two for the back of my hand. I have all night.

Every postburn cigarette is as good as the one after an egg sandwich with ham and American cheese on a toasted, buttered English muffin. Good as the one you light up after masturbating. Consummate. The first-of-the-day-sip-of-fresh-hot-milky-coffee right. One in a pack of twenty. Resplendent.

CHAPTER 2

Medical Emergency

The plane ticket tells me nothing more than the dull geography of my future: BTV–BWI. One way, 9:00 A.M., Wednesday, 9/10/91. It’s a cryptic string signifying my flight from Burlington International Airport to Baltimore Washington International Airport on what will turn out to be a practically tropical September day. On the 11th—the day after tomorrow, at which point there will be precisely 111 days left in the year—I will be admitted to the locked ward of the Sheppard and Enoch Pratt Hospital as soon as it opens for business. It’s happening. Dr. Kohl’s letter reads:

September 10, 1991

To Whom It May Concern:

This letter is to substantiate that Cree LeFavour is undergoing a severe medical emergency necessitating immediate hospitalization.

Sincerely,

Adam N. Kohl, M.D.

Dr. Kohl laid my options before me like richly patterned carpets I might wish to go home with—or not. That was the day I blew the contract I’d signed a month or so prior: my promise to stop burning. In writing, in my file, was an impossible-to-dispute paper. I’d agreed that if I did burn myself even one more time I would go to a psychiatric hospital. Or never see him again. It’s not even a close contest. My profound attachment to Dr. Kohl makes my choice simple. I’ve agreed to check myself in.

If I don’t sign the voluntary admittance papers once I arrive at the hospital in Baltimore, if I prefer not to board the plane, Bartleby style, just one glance at the mess I’ve made of the skin on my arm will be enough for Dr. Kohl to rally any two psychiatrists and a judge in either Vermont or Maryland to agree to an involuntary commitment, otherwise known as a civil commitment. This, he argued, will happen whether I decline to admit myself or sign myself out once I’m in. A stay there is the only way to return to Dr. Kohl for treatment. He won’t see me again unless I stay as long as I need to and earn honorable discharge. Then, and only then, can I come back to him at 112 Church Street to sit in my favorite chair. That was his play anyway; I’ll go if I can have him.

This mess I’m in, sitting up through the night waiting for morning, playing with fire while I still can, began with ruthless scientific clarity a bit over a year ago. That was the day of my first appointment with Dr. Kohl. I went to him because I was a bulimic, unhappy, confused twenty-four-year-old. What I wanted, though I couldn’t admit it to myself when I walked into his office for the first time, was for someone to recognize I needed help. The bulimia was just an excuse to get myself in the door; what I yearned for without expecting to find it in Dr. Kohl was an inchoate balm to soothe the lack I felt. I never once believed it was a thing that could be made, found, or bought.

For too long, as long as I can remember, I’ve been uncertain whether the effort to keep going day after day is worthwhile. Although there have been many times when I’ve felt alive and happy to be so, the older I’ve gotten the more exhausting it has become to don an acceptable disguise to present, one convincing enough to keep people from recognizing the odious, unworthy, deeply unhappy person beneath.

In going to a psychiatrist I feared seeking attention, asking for what I didn’t need or deserve. Part of me still believes there’s nothing wrong with me, or nothing self-discipline can’t fix. The cycle of self-loathing goes on and on, part of what Freud called the compulsion to repeat, in which the drive toward the inevitable end takes on a dark, unruly pattern. I’m more confused than ever about who I am and what I want, and yet in some form this feeling has been with me as long as I can remember. Maybe there’s something fundamentally off and unfixable about who I am that makes me want to escape. What’s worse is that some part of me likes it—a familiar masochism deep within relishes how special this shitty core makes me feel, how different I am from everyone else because of it.

My mind was less right than it ever had been when I asked for that first appointment with Dr. Kohl. My dreams were blurring the line between sleeping and waking, and the scary hallucinatory essence that followed me out of slumber was closing in on the day. Reality was slipping, nudged out by the presence of an ungainly force pressing against me.

Maybe that’s why, when Dr. Kohl asked me on that first day, What’s your greatest fear? the answer formed like a memorized line delivered slightly off cue, a beat too fast.

Losing my mind.

Taller than me—and I’m six feet—he’s trim, well proportioned, and wears what most upper-class East Coast males wear at leisure: soft earth-tone sweaters, button-down shirts in subdued blues, khaki pants, and plain leather lace-up dress shoes. My father dresses much the same way. Dr. Kohl is precisely put together and comfortable in his body, never fidgeting or shifting his penetrating gaze to escape mine. His brown eyes communicate a dangerous intelligence and sensational warmth. His plain brown straight hair is cut short. He has no scent—or maybe I’ve never gotten close enough to discern any. Being in his presence is to be recognized. From the moment he called me in from the waiting room and closed the door behind us that day I wanted what he had—a centered self.

His corner office occupies the ground floor of a two-story white-painted brick building in downtown Burlington. Three other psychiatrists share the building with him. The efficient receptionist answers the phone and writes out names, times, and dates on the doll-size appointment cards she hands to patients. She is master of the blocks of minutes that are transmuted into sessions she types out as billable hours on a humming dusty-blue Smith-Corona. The receptionist’s handling of the grubby business of dispensing bills and collecting checks made out to Dr. Kohl confirms Freud’s observation that money matters are treated by civilized people in the same way as sexual matters—with the same inconsistency, prudishness, and hypocrisy.

Where we sat that first day and in the year and two months since, the space I’ll find tomorrow before I leave for the airport, is tasteful and understated with a worn couch upholstered in Bing cherry velvet positioned under a wide horizontal window. I sit on the leather swivel chair facing him. His broad desk angles away from the wall, its position blocking any view of the framed photographs there. A side table with a clock and a box of tissues separates the couch and my beloved chair—the one I’ve collapsed into session upon session right from the beginning.

After the first time, I remember sliding the magic token of an appointment card into my back pocket with only one of the six lines completed: 7/19/90, just like the one I have now marked for tomorrow—9/10/91. Dr. Kohl’s name is printed on top, immediately beneath the line for my name, M __________________ HAS AN APPOINTMENT WITH, and then DR. ADAM N. KOHL. Six blank lines skip down the length of the card with space for the date punctuated by AT followed by a smaller blank for the time.

As I drifted down the sidewalk in the garish light reflecting off Lake Champlain that first day, I imagined a completed card, even a full deck, the ink expanding accordion-like down linked rectangles representing future time in his presence.

CHAPTER 3

IPE

Initial Psychiatric Evaluation (IPE)—Date of Evaluation: 6/26/90; Referred by: Self; Patient’s Name: Cree LeFavour; Sex: ; Age: 24; Birth Date: 9/20/65.

1.  PRESENTING PROBLEMS:

I’d like to pinpoint why I’m unhappy. (Though I’ve felt a lot worse.) I’ve been really depressed.

Rxs [symptoms] of her depression:

1.  I hide completely, shut self off, don’t speak, isolation is really key. Need. I find a lot of freedom in that.

2.  Feel a need to escape and not contact anyone.

3.  Abstain from everything, including food.

4.  Sleep as reaction to depression.

Relationship: 1. ‘I feel like Matthew’s mother.’ This has brought something out in her. ‘I used to be more independent, more myself.’

As a psychiatrist with an M.D. from Johns Hopkins might do, he probed my mind during the first appointment as if he meant to take a scalpel to it, his purposeful manner failing to suppress the attar of sympathy that memorably bathed every one of my senses. Emboldened by my instinct that it was my only chance to show him everything—What you say here is confidential—I told the truth, blushing when he asked me how often I had sex and if I had orgasms. His directness and interest in the minutiae of my biography tempted my starving narcissist to deliver monologues I didn’t know I’d been waiting to perform.

The IPE proceeds:

2.  RECENT STRESSORS: He checks Pregnancy and notes abortion in the column EXPLANATIONS. He also checks Marriage, Divorce, Separation, Argument, adding, Relationship with Matthew Agnew. He checks Change in Residence but not Sexual Difficulties. I miss out on Sudden Increase in Wealth, Extended Vacation. If only.

3.  PAST PSYCHIATRIC HISTORY: All questions beginning with When last felt well on through Prior psychiatric treatment with __________ and Drug, Individual and Group Therapy, ECT, Hospitalizations, Longest period without psychiatric care, Diagnosis, Successful medications, Medication problems are blank or show a 0.

4.  PAST PSYCHOLOGICAL HISTORY—CHILDHOOD: He checks Yes for Math difficulty, Falls or accidents, Left handed, Nightmares, Fear of dark, Death or separation in family, and Frequent moves. I’ve happily escaped a check in the Yes column for Cruelty to Animals, Fire Setting, and the ominous Promiscuity, deviation, incest.

5.  PRESENT PSYCHOSOCIAL AND NEUROPSYCHOLOGICAL HISTORY: He checks Yes for Phobias, Obsessions, Rituals, and Excessive Eating, Vomiting (None for 3 months; used to do it more), Speeding (Likes to go 85 mph), High Fever (When younger), and Dizziness (Fainted once). He adds and underlines, Severe Nightmares. Even if bulimia was my ticket in the door, my up-front reason for going, it was a symptom that paled next to my scary obsessions. I wasn’t going to go into this private madness straight off; I just said yes when he asked if I had obsessions.

6.  MEDICAL HISTORY: He notes, Broke limbs falling off horses and circles the words Alcohol, Cigarettes, and Street Drugs. I tell him I’ve smoked, swallowed, or chewed marijuana, cocaine, hallucinogenic mushrooms, ecstasy (MDMA), and speed. But I don’t do any drugs now nor have I done any for at least three years. I drink very little these days—a beer now and again.

7.  FAMILY HISTORY: Father (56) and mother (52) divorced in 1981. Father is a chef and lives in St. Helena, California. Throughout her childhood he owned restaurants in Aspen, Idaho, and California. Mother lives with her partner in Eureka, CA. Sister, Nicole, good health, close, lives in Idaho. He then asks me for maternal and paternal history of various mental disorders. He marks Yes for a history of Depression; Mental Illness, Alcohol, and Drug Use; Eccentricity, Creativity; Aggression, Mood Swings, and Financial Problems. As a whole we LeFavours managed to escape Yes to Attempted/Committed Suicide along with various physical disorders like Cancer, Stroke, and Color Blindness. We seem to have the remainder covered.

8.  MARITAL AND SEXUAL HISTORY: Under If Female in the column Most of Life he checks Difficulty Getting Excited, Disinterest in Sex, and Masturbation, noting after the last, Don’t now, in this relationship. All but one of the remaining questions have checks under Never, including H/O Fetishes, Cross-Dressing; Reaching Orgasm Too Quickly; and Sexuality with Females. Contraception: Diaphragm. Frequency of Intercourse: 3 x/week. Under the remaining Different Sexual Habits he writes ???

9.  EDUCATION: Middlebury, B.A. 1988

10.  WORK AND FINANCIAL HISTORY: Chittenden Community Action. Helps people with welfare problems. He notes to himself, Emotionally really dangerous.

11.  HOBBIES, SPORTS HISTORY: Read a lot—no favorite. Used to compete x country skiing (high school). Now I don’t exercise.

12.  RELIGIOUS AND SOCIAL HISTORY: Parents both atheists, me too.

13.  MILITARY HISTORY: 0.

The final part of the form has a separate title: MENTAL STATUS EXAMINATION (IPE). He skips all but two of the unnumbered sections, including categories for BEHAVIOR, BEHAVIORAL EXPRESSION OF AFFECT, and DISORDERS OF SPEECH. Under COGNITIVE FUNCTIONING he completes only Estimated Intelligence: Above average. He then skips all but the last part of the longest category, APPERCEPTUAL FUNCTIONING, including Hallucinations, Thought Disorder, and Delusions, to focus on Proverbs and Similarities: Stitch in Time, Bird in Hand, and Glass Houses. I pass, completing the phrases with the correct proverbs and explaining the meaning of each. It was a fairly simple, not particularly accurate test of abstract reasoning—proverbs are, after all, culturally specific. I came up cold on Burnt Child. (The answer is, A burned child dreads the fire, meaning we learn to avoid harm through painful experience. At the time, having never burned myself with a cigarette, I didn’t recognize the uncanny significance of my failure to complete the phrase.) My reply to the final partial proverb, Tongue Is Enemy, was apparently worth note: Talk too much get head cut off. What an odd proverb to include on a questionnaire to launch a course of psychotherapy. Similarities are: Orange—Apple: Fruit, Airplane—Bird: Fly, and Man—Squirrel: animals.

ASSESSMENT

1.  Symptoms (DSM-II)

Axis I: Bulimia

Axis II: "Bulimia with vomiting long history

History of depression

History of severe drug abuse (alcohol, cocaine, amphetamines)"

2.  Circumstances Associated with Symptoms

a.  Environment: F/H [family history] alcoholism.

b.  Physical Illness: handed, eyed.

c.  Drug Abuse: Alcohol abuse in college; heavy use of amphetamines, 1987 (6 weeks); periods of regularly using cocaine but not for long (2 weeks).

d.  Other: Severe family deprivation (left totally alone at age 13). Learned to survive alone so she equates surviving with aloneness. I tell him, My mom not a mom, just not mothering type. He writes, Aloneness is source of depression. I report that my sister and I had lived alone since I was in 9th grade. It’s just the way it was. LITTLE BUDDY = small child who was totally unattended. That was my mother’s favorite nickname for me. Rosy Rotten Crotch was another.

PLAN:

1. Discussed alcohol, speed, cocaine with her. What he said was if I was doing drugs or drinking there was no point to being in therapy.

There is no number two. Time was up.

The IPE interview was not my first encounter with Dr. Kohl. I’d been to his office once before as a favor to my then boyfriend, Matt, who asked me to come along to one of his weekly appointments with Dr. Kohl. These sessions were mandatory—whether by agreement with his parents or by court order. Matt told me only that there was an incident in high school. Despite our living together for more than a year the explanation remains